Provider Demographics
NPI:1750674206
Name:HAMRICK, CHARLES VINSON
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:VINSON
Last Name:HAMRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 W NC HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5505
Mailing Address - Country:US
Mailing Address - Phone:919-489-5814
Mailing Address - Fax:919-493-4439
Practice Address - Street 1:1311 W NC HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5505
Practice Address - Country:US
Practice Address - Phone:919-489-5814
Practice Address - Fax:919-493-4439
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist